825 health worker migration the case of the philippines

8/2/2019 825 Health Worker Migration the Case of the Philippines

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Health Worker Migration: The Case of the

Philippines

XVII General Meeting of the Pacific Economic Cooperation CouncilSydney, Australia, 1-2 May 2007

Maruja

M.B. Asis

Scalabrini Migration Center


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Outline of the Presentation

Introduction: health worker migration in the global agendaHealth worker migration from the Philippines

Health worker migration in the context of the Philippinesextensive migration experience

Debates on brain drain, care drain and other issues

Attempts to address health worker migration

Concluding reflections

Examples of regional initiatives dealing with health workermigration

The need for a framework of cooperation


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Health Worker Migration

The health of nations is increasingly becoming a transnationalissue.

Shortage of local health workers and professionals isaddressed by importing such workers from the developingcountries.

Health worker migration highlights demographic and economicdifferentials between the developed and developing countries.

Increased demand for health care mainly due to the ageingof the population in the developed countries.

Views on health worker migration reveal competing interests.Health workers have the right to migrate.The migration of health workers is part of globalization(WTO).

Health care is a basic social service, thus, the departure ofhealth workers can affect the health delivery system (WHO).


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The category of health workers encompasses a variety ofpeople in the health care sector.

WHOs definition of health workers:

all paid workers employed in organizations or institutions

whose primary intent is to improve health as well as thosewhose personal activities are primarily intended to improvehealth but who work for other types of organizations

Two categories:

Health service providers

Most data refer to doctors, nurses and midwives; WHRmostly refer to these health workers.

Health management and support workers


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The loss of health workers cannot be fully compensated byremittances, transfer of knowledge or return migration.

2004 WHO General Assembly passed a resolution for memberstates:

to develop strategies to mitigate the adverse effects of migrationon health personnel and minimize its impact on health systems.

The World Health Report (WHR) 2006 focused on healthworkers.

59 million health workers worldwide; countries with the leastneed have the most number of health workers

WHR 2006 noted a shortage of 4.3 million workers, with sub-Saharan Africa having the most severe shortage

Nurse migration has received the most attention.


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Brain drain, care drain and other issues have to consider 5scenarios of nurse migration (Pittman, Aiken & Buchan, 2007):

Sub-Saharan Africa - direst scenario; poorly developed healthsystem; most in need of health workers; govts call on wealthygovts to curb recruitment

English Caribbean relatively better health systems patterned afterthe UKs; govts are seeking to improve retention rates

Low-to-middle income countries with a labor export program (e.g.,Philippines) relatively weak health systems; labor export program

attracts recruitersUK and Canada they lose some nurses to other countries; UK hasintroduced some measures to enhance self-sufficiency

US unique because it loses few nurses; attracts the mostnumber of nurses; has the greatest need for nurses


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Currently, the recruitment field has become global; brain drainand care drain concerns and the capacity to mitigate theseproblems by countries of origin vary.

The role of private recruitment agencies must not be ignored.

Health worker migration (esp. nurses) is highly feminized; thishas implications on other care issues.

Impacts on the migrating health workers should not be ignoredAlthough they are not as vulnerable as less-skilled workers, healthworker migration also raises rights issues.Race, nationality, and gender factors operate in the recruitmentand treatment of health workers.


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Health Worker Migration from the Philippines

The Philippines is a traditional source country of healthworkers.

In the 1960s, the migration of doctors and nurses to countries ofsettlement, mostly to the US, raised concerns about brain drain.

The health professions had been closely associated with migration;health care is a sector where the Philippines has established aniche.

The Philippines foray in international labor migration also

shaped health worker migration.The state became a key player in facilitating labor migration.

Destinations became more diverse GCC countries, East &Southeast Asian countries, Ireland are major destinations.

Recruitment agencies play an important role in the migrationprocess.


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Health worker migration is a major component of highly skilledmigration from the Philippines.

The US, a traditional country of destination of Filipino nurses(also doctors and other health workers), has been shaped by

historical factors as well (Ceniza-Choy, 2003).By the 1980s, the GCC countries emerged as new destinations.

By the 1990s, Asian NICs and Europeans countries (UK andIreland) figured as major destination countries.

Between 1992 & 2003, total of 87,852 nurses were deployed(Philippine Overseas Employment Administration data); this isan undercount.

Other health workers on the move: doctors, dentists, medical

technologists, physical therapists, midwives, X-ray tech etc.


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Health worker migration, nurse migration inparticular, does not lead to shortage per se.

However, it has led to marked distortions in healthcare delivery and human resource development:

There is a shortage of skilled, specialized and experiencednurses, whose departure has an impact on service delivery.

There has been a proliferation of nursing schools/programs;quality of nursing education has been affected.

Due to demand, doctors are studying to become nurses.

The oversupply of nurses is likely to distort the countryshuman resource portfolio.


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Stock of nurses: 332,206Demand: 193,223

Oversupply: 139,083

Of 193,223 employednurses:

Local/National

29,467 (15.25%)

International 163,756 (84.75%)

(source: Lorenzo, 2005)


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Commercialization of nursingeducation

40 nursing schools in the1970s

now: 441 nursing colleges(vs. 30 medical, 31 dental,35 pharmacy, 95 PT/OTcolleges)

Declining quality as indicated

by lower passing rate, about50% since the 1990s

(Source: Lorenzo, 2005)

Doctors turned nurses3,500 nurse medics haveleft since 2000

Decline in medicalenrollment (while some

4,000 are enrolled innursing programs

Increased vacancies forMDs & RNs in 8 regions

Other second coursersA country of nurses?

Aspirations of youngFilipinos


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The right to migrate vs. the societal impact ofindividual migration decisions

Low pay (US$200 vsUS$3,000-4,000)

Better working conditions

Better future for the family

Immigration possibilities forthe family


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The Philippines must address supply-side factors; healthworker migration is a symptom of other problems.Attempts and proposals to address health worker migration:

Policy measures to improve working conditions; retention-orientedpolicies wage differentials, however, will continue to pose a

challengeFormulation and implementation of a Health Human ResourceDevelopment ProgramMore engagement with countries of destination for cooperation ondevelopment programs in general, and health human resource

development in particular.Promoting medical tourism

DEMAND-SIDE factors, including aggressive active recruitment,particularly with the participation of recruitment agencies, mustbe addressed as well.


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Regional Initiatives

In general, migration-related initiatives in the Asia-Pacific havefocused on discussions on trafficking in persons, and to someextent, irregular migration.

Highly skilled migration, of which health migration is a part, hasbeen overshadowed by concerns over the much larger lessskilled migration.

The discussions on highly skilled migration seem to ignore itscosts relative to its perceived positive impacts, esp. forcountries of origin.

Countries of destination compete for highly skilled and professionalmigrants.

Countries of origin, such as the Philippines, are eyeing more highlyskilled migration in lieu of less skilled migration.


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To date, regional and bilateral initiatives focus on facilitating themovement of health workers:ASEAN Framework Agreement on Trade in Services signed in1995 by the ASEAN Economic Ministers; aims to achieve a free

flow of services by 2015 includes health careASEAN cooperation in trade in services also includes MutualRecognition Agreements (MRAs) to facilitatethe movement ofprofessional service providers in the region; two MRAs havebeen signed, Engineering Services and Nursing Services

ASEAN MRA on Nursing Services was signed on 8 Dec 2006The Japan-Philippines Economic Partnership Agreement includesprovisions on the entry of qualified Filipino nurses andcareworkers to Japan.


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The need for bilateral/regional cooperationHealth worker migration cannot be approached as a labor ortrade in services issue

More regional and broader discussions on highly skilled

migration in general, and health worker migration inparticular

More govt-to-govt arrangements can broaden possibilitiesfor cooperation and shared responsibilities

Better data and more studies on the intra-regional migrationof other health workers; to date, the focus has been onmigration to western countries and nurse migration

825 health worker migration the case of the philippines

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